International journal of diabetes mellitus最新文献

Background

Peripheral neuropathy (PN) is a common neurological complication in patients with diabetes mellitus (DM) which affects their quality of life.

Objective

To determine the frequency of PN and the risk factors associated with its occurrence in the studied diabetic patients.

Subjects and methods

A cross sectional study was conducted in Al-Azhar University Hospitals, Cairo, Egypt. The study recruited 300 patients with type-II DM who attending the outpatient diabetic clinics in the studied hospitals, from October 1st 2005 through January 2006. A clinical neurological examination was conducted for all patients using the Michigan Neuropathy Diabetic Scoring (MNDS) criteria for diagnosis of PN. Subsequently, we considered patients with PN as study cases, and those without PN as controls to assess the risk factors associated with PN. Statistical analysis including multivariate logistic regression analysis was done.

Results

The frequency of PN among the studied subjects was 29.7%. Related risk factors were: older age above 60 years (odds ratio (OR) = 73.0; 95% confidence interval (CI) = 14.2–377.2), associated moderate to severe hypertension (OR = 10.2; 95% CI = 2.8–38.0) and associated ischemic heart disease (IHD) (OR = 3.80; 95% CI = 1.50–9.80), poor control of DM (OR = 9.1; 95% CI = 2.6–32.1), and duration of DM. The risk of PN, however, was significantly reduced among married patients and those reported high educational and family income levels.

Conclusions

Diabetic PN is a considerable complication of DM. The related risk factors were old age, prolonged and poorly controlled DM and associated medical disorders.

Surgical removal of the insulinoma continues to be the treatment of choice. Medical therapy should be considered in patients who cannot undergo surgery. We are reporting our experience with regard to the efficacy of Diphenylhydantoin (DPH) in controlling hypoglycemia and suppressing insulin release in patients with insulinomas. DPH was administered orally at a dose of 300–400 mg/day to three patients with documented endogenous insulin excess. The first two patients received the drug temporarily during the preoperative period, with resolution of the hypoglycemic attacks, normalization of blood glucose, and reduction of insulin levels. Subsequent surgery confirmed the presence of insulin-secreting pancreatic tumor. Cure was achieved after excision of the tumor. The third patient represented a diagnostic and threrapeutic challenge. An insulin-secreting tumor located in the body of the pancreas was diagnosed in a patient with type 2 diabetes and end stage renal disease. The patient’s poor cardiac function contraindicated surgery. DPH resulted in an excellent sustained control of his blood sugar and a fall in insulin levels for several months. We believe that DPH is a potent inhibitor of insulin secretion and, thus, is suitable as a temporary therapeutic measure in the preoperative period of patients with insulinoma, as well as an alternative to surgery for those who are not surgical candidates.

Apoptosis may play a crucial role in the pathogenesis of late diabetic neuropathy. We determine the role of Fas mediated apoptosis in the aetiopathogenesis of diabetic neuropathy, by measurement of apoptosis markers, induction of apoptosis by Fas and/or serum and correlate the level of soluble Fas (marker of apoptosis) with the nerve conduction study. Furthermore, we elucidate the role of apoptosis inhibition in prevention of diabetic neuropathy by the Fas blocker (ZB4).

There was significant increase in the sFas serum level in diabetics with neuropathy as compared to the controls and diabetic patients without neuropathy (p < 0.005). All parameters of the motor median nerve conduction study showed significant correlation with the serum sFas levels, especially the nerve conduction velocity (r = −0.60, p < 0.01). Cells treated with the serum of diabetic patients with neuropathy showed significantly higher percentages of early and late apoptosis (p < 0.05) compared to the negative control. A 500ng/mL Fas blocker (ZB4), antagonistic anti-Fas antibody caused significantly lower levels of early and late apoptosis (p < 0.025) compared to serum of diabetic patients with neuropathy treatment.

In conclusion, Fas-mediated apoptosis of the neuronal cell line is responsible for the degradation of the neurons in patients with diabetic neuropathy and provides evidence for the involvement of the receptor pathway in Fas-mediated apoptosis of these cells. Thus, targeting and inhibiting Fas receptor offers an option for diabetic neuropathy therapy.

A 42-year-old diabetic female complained of cough, mild dyspnea, malaise and weight loss. Red tender eye. Fundus with multiple white granuloma lesions. Fine crepitation was found in the right middle zone. Serum ACE level was high, and HbA1c was high. Chest X-ray revealed pulmonary infiltration in the right lower lobe, CT of the chest confirmed the same finding. A definitive diagnosis of sarcoidosis was made by histological study of the specimen by bronchial biopsy which revealed non-caseating granuloma.

Background

With increase in type 2 diabetes mellitus patients the complications of diabetes are being seen more frequently. Patients with diabetic neuropathy often present with distressing symptoms such as pain and burning sensation in the feet. Tarsal tunnel syndrome with electrophysiological changes may be a causative or contributing factor. The present study was designed to assess the presence and features of tarsal tunnel syndrome in diabetes mellitus patients.

Method

In this study a group of 10 normal volunteers were selected who had no neurological complaints or foot trauma. Another group of 33 patients having longstanding diabetes mellitus with complaints of pain, burning sensation and paraesthesia in the feet were selected for electrophysiological tests and median plantar nerve was studied.

Results

In the present study we observed that 15 (45%) of diabetic cases showed abnormal findings e.g., prolonged distal motor latency, decreased amplitude of M-response, low or absent sensory response suggesting tarsal tunnel syndrome.

Conclusion

This study shows that the tarsal tunnel syndrome may be present in a significant number of diabetic patients with subjective neuropathic symptoms in the feet. The tarsal tunnel syndrome should be kept in mind during the diagnostic workup and management of diabetes mellitus.

Diabetic patients may present with Lisfranc’s Fracture Dislocation which may be confused with osteomyelitis. Rapid diagnosis and early intervention can prevent deformity. We suggest that the diagnosis of Charcot’s foot should be considered in any diabetic patient with unilateral swelling of lower extremity and/or foot.

Background

Heterogeneous familial hypercholesterolemia (HFH) partly underlies polymorphic changes in the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB) and protein convertase subtilisin/kexin type 9 (PCSK9), exhibiting intra-ethnical variations in its clinical features.

Methods

We employed the Affymetrix whole genome scan 250 sty1 array to characterize possible genomic linkage to heterozygous familial hypercholesterolemia (HFH) and sequencing techniques to identify related mutations in the above three genes in a Saudi family of 11 individuals harbouring clinical features of FH. The propositus had early onset of coronary artery disease (CAD) and very significantly elevated cholesterol (Chol) level of 10.1 mmol/L and LDL-cholesterol (LDL-C) of 7.9 mmol/L as well as low HDL-C level of 0.51 mmol/L, while 4 siblings were affected with HFH.

Results

Whole genome scan for the autosomal dominant model showed high homology for the affected individuals in several regions including chromosomes (chr) 1 and 2 which harbour PCSK9 and APOB, respectively. Subsequent sequencing of the coding regions of these two and LDLR identified 11 single nucleotide polymorphisms (SNPs) in the LDLR, 8 in the APOB and 6 in the PCSK9 genes. The propositus uniquely carried the homozygous mutant genotypes (haplotype) for all 11 LDLR SNPs, in direct contrast to the only normolipidemic sibling and a control who carried the homozygous wild type genotypes at these loci. Another set of 7 SNPs in the APOB also isolated with FH. Interestingly, all family members were heterozygous for all except the rs2228671 C > T of this gene, for which the mother shared the C/C genotype with the propositus, two other affected off-springs and a control, all of whom exhibited low HDL-C levels. A confirmation experiment involving 70 individuals harbouring low HDL-C revealed 74.3% of them as C/C carriers.

Conclusions

Our study identified a haplotype in the LDLR as a marker for early onset of CAD, and rs2228671 C > T in the LDLR in association with a reduction in HDL-C concentrations in FH. The results also substantiate the notion of genetic heterogeneity in HFH, underlining the essence of recognizing ethnic-specific gene variability as a potential basis for appropriate management of FH.

Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) are not only a surrogate for the state of insulin resistance but are also associated with the microvascular and macrovascular complications traditionally linked to diabetes. They predict an increased risk for death and morbidity due to cardiovascular disease.

There is growing evidence that early detection of this state of “pre-diabetes” enables us to limit these recognized complications and perhaps to halt the progression to diabetes. For all pre-diabetes patients’ life style modifications, emphasizing modest weight loss & moderate physical activity are strongly recommended. Pharmacological intervention may also be necessary. Many studies have shown several drugs, both antidiabetic and nonhypoglycemic agents to be useful. If pharmacological treatment is required, Metformin is considered the first choice because of its safety, tolerability, efficacy and low cost.